Timing of aneurysm surgery

Summary In a retrospective study covering a period of 8 years and 403 surgically treated patients the results of microsurgical aneurysm treatment were compared between two groups. One group received surgical treatment within 72 h and the second were treated surgically after this time interval. The data indicated that patients receiving delayed surgery had a better outcome at 6 months as compared to patients receiving immediate surgical intervention. The location of the aneurysm and the preoperative neurological status imparted the most significant impact on the subsequent outcome and on the incidence of rebleeding. High risk patients with poor neurological status on admission seemed to have a considerable chance of gaining satisfactory functional recovery, especially with a more delayed surgical approach. Despite its superior results delayed surgery was burdened with a rebleeding rate and an incidence of ischemic deficits due to cerebral vasospasm twice as high as in patients receiving early surgery. The implications of these results on surgical timing are discussed and it is concluded that despite the fact that late surgery yields better results than early surgery, the considerable reduction of recurrent hemorrhage and additional possibility of aggressive treatment of incipient vasospasm makes early surgery a promising alternative for the treatment of patients with aneurysmal subarachnoid hemorrhage.